Provider Demographics
NPI:1700980307
Name:RODRIGUEZ, DAVID A (M D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 SW 74TH CT STE 1706
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3176
Mailing Address - Country:US
Mailing Address - Phone:305-670-0260
Mailing Address - Fax:305-670-2665
Practice Address - Street 1:8950 SW 74TH CT STE 1706
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3176
Practice Address - Country:US
Practice Address - Phone:305-670-0260
Practice Address - Fax:305-670-2665
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050087207N00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052393300Medicaid
FL04264YMedicare PIN
FL052393300Medicaid